Upper aero digestive tract cancers: epidemiological and histopathological aspects in Togo

International Journal of Otorhinolaryngology and Head and Neck Surgery Foma W et al. Int J Otorhinolaryngol Head Neck Surg. 2017 Jan;3(1):11-16 http:/...
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International Journal of Otorhinolaryngology and Head and Neck Surgery Foma W et al. Int J Otorhinolaryngol Head Neck Surg. 2017 Jan;3(1):11-16 http://www.ijorl.com

Original Research Article

pISSN 2454-5929 | eISSN 2454-5937

DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20164803

Upper aero digestive tract cancers: epidemiological and histopathological aspects in Togo Winga Foma1*, Bathokedeou Amana1, Essobozou Pegbessou1, Haréfétéguéna Bissa1, Saliou Adam1, Warou Dolou2, Tchin Darré3, Essohanam Boko2, Eyawèlohn Kpemissi1 1

Department of ENT and maxillofacial surgery, 3Department of Pathological anatomy, Sylvanus Olympio Teaching Hospital of Lomé in Togo 2 Department of ENT, Campus Teaching Hospital of Lomé in Togo Received: 11 September 2016 Revised: 22 October 2016 Accepted: 07 November 2016 *Correspondence: Dr. Winga Foma, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: The objective of the study was to describe the epidemiological and histopathological aspects of cancer of the upper aero digestive tract (UAT) in a reference service in Togo. Methods: It was a retrospective study about UAT cancers diagnosed in the ENT and maxillofacial surgery department of Sylvanus Olympio Teaching Hospital of Lomé in Togo from 1st January 2005 to 31 December 2014, or a period of 10 years. Results: The UAT cancers represented 0.3% of consultations and 64.8% of head and neck cancers. The average age of patients was 51.3 years (± 16.5) with extremes of 3 months and 86 years. The sex ratio was 1.77. Chronic smoking was found in 26.4% of patients with 1.6% of women; that of chronic alcoholism among 43.8% of which 7.7% of women and the simultaneous alcoolotabagisme in 20.9% of patients. The UAT cancers were dominated by cancers of the oral cavity (36.2%) with particularly a female predominance (53.2%), followed by the oropharynx (18.5%) and the larynx (18.1%). The squamous cell carcinoma was predominant in UAT cancers (83.5%) followed by nonHodgkin lymphoma (8.9%) and adenocarcinoma (2.7%). Conclusions: UAT cancers are the largest contingent of head and neck cancers in Togo. They occur most often in men from the fifties but there are a high proportion of women. Histology is dominated by squamous cell carcinoma. Keywords: Epidemiology, Cancer, Upper aero digestive tract, Togo

INTRODUCTION Ear nose throat (ENT) cancers are essentially those of upper aeorodigestive tracts (UAT) developed at the expense of oral cavity, pharynx, larynx and sinonasal cavities. UAT cancers present unity characters which are common to them and give them a particularly place in carcinology domain: region’s anatomy, physiology, histopathology, epidemiological and etiological conditions and natural history of those cancers.1 They constitute a perfect example of the importance of epidemiological studies but also of their limits. The

majority of those cancers were largely associated to an intense alcoholism and smoking which etiological influence in those cancers genesis can be precisely evaluated.2 In most sub-Saharan countries and particularly in Togo, the frequency of cancers is difficult to situate precisely in absence of national morbidity registers, what limited the epidemiological surveillance. This study’s objective is to contribute to lay the epidemiological and histopathological foundation of UAT cancers in Togo.

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METHODS

Age and sex

It was a retrospective study about UAT cancers diagnosed in ENT and maxillofacial surgery department of Sylvanus Olympio Teaching Hospital from 1 st January 2005 to 31st December 2014, thus a period of 10 years. The data were collected from the patients’ folds and the register of the histopathological results of surgery pieces and biopsies analysed in pathological anatomy department of that Teaching Hospital in majority and in some cases in private laboratories in Lomé and France. The histological examination techniques used in Sylvanus Olympio Teaching Hospital were conventional pathological anatomy examination and histochemistry techniques. Patients with lesion even of malign appearance without histopathological proof and those having metastasis of UAT from others cancers were not included in this study. The data were sized and analysed by Epi Info 7 logical; the characteristics studied comparison by Chi2 or odds ratio homogeneity tests when every series presented at most two modalities. Decisions were taken with a risk α of 5%.

Mean age was 51.3 years (± 16.5) with extremes of 3 months and 86 years. That mean age was 49.7 years in females and 52.2 years in males. The number of UAT cancers was more important in the class of patients that had more than 60 years (35%). The Figure 2 shows the distribution of cancers by age and sex. Ninety four patients (36.2%) were female and 166 (63.8%) males. the sex-ratio was 1.77. Males were predominant in the cancers of cavum (62.5%), oropharynx (70.2%), hypopharynx (69.2%), larynx (85.1%), nasal fossa and sinus (72.1%), contrary to female in the cancers of oral cavity (53.2%).

RESULTS Epidemiological aspects Frequency In the period of the study, 260 cases of UAT cancers were histologically diagnosed, which represented 0.3% of consults and 64.8% of ENT and maxillofacial cancers. The most elevated size was counted in 2013 with 59 cases and the lower during 2005 with 10 cases (3.8%). The Figure 1 shows the distribution of cancers by years.

Risk factors In general, idea of chronic smoking was found in 26.5% of patients in which 1.6% of females; the one of chronic alcoholism in 43.8% of whom 7.7% of females and the one of simultaneous alcoholism and smoking in 20.77% of patients. The alcohols most found in all patients were local alcoholised drinking (alcohol of palm wine and sorghum) and beer. The tobacco was consumed in cigarette form in 97.1% of cases and in powder to prize in 2.9%. For the cancer’s siege, simultaneous alcoholism and smoking was found in larynx’ cancer with 37.04% of cases, followed by oropharynx (25.93%), oral cavity (18.52%), nose and sinus (11.11%) and hypopharynx (7.4%) as in Table 1. Hygienic state of oral cavity was specified in 100 patients. In this group, we quote 18 cases (18%) of poor oral hygiene. We have quote an association between cancers of the oral cavity with wicked oral hygiene as in Table 2.

Table 1: Siege and simultaneous alcoholism and smoking.

N(%) 260 (100) Larynx cancer Yes 66(25.38) No 194(74.62) Oropharynx cancer Yes 46(17.69) No 214(82.31) Oral cavity cancer Yes 85(32.69) No 175(67.31) Nose and sinus cancer Yes 34(13.08) No 226(86.92) Hypopharynx cancer Yes 22(8.46) No 238(91.54)

Simultaneous alcoholism and Smoking RR Yes No n(%) n(%) 54 (20.77) 206 (79.23) 1.7291 20(37.04) 46(22.33) 34(62.96) 160(77.67) 1.6283 14(25.93) 32(15.53) 40(74.07) 174(84.47) 0.4679 10(18.52) 75(36.41) 44(81.48) 131(63.59) 0.8309 6(11.11) 28(13.59) 48(88.89) 178(86.41) 0.8655 4(7.41) 18(8.74) 50(92.59) 188(91.26)

95% Confidence Interval Lower

Upper

p*

p**

1.0737

2.7845

0.0165

0.0419

0.9694

2.7350

0.0438

0.1139

0.2478

0.8837

0.0056

0.0197

0.3854

1.7915

0.3285

0.7990

0.3449

2.1718

0.3964

0.9697

RR= Risk Ratio; * Mid-p exact; ** Chi-square test

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Table 2: Oral cavity cancer and oral hygiene.

N (%) 100(100) Oral cavity cancer Yes 30(30) No 70(70)

Oral hygiene Poor Good n (%) n (%) 18(18) 82 (82)

RR

2.9167 10(55.56) 8(44.44)

95% Confidence Interval Lower

Upper

p*

p**

1.2776

6.6587

0.0071

0.0199

20(24.39) 62(75.61)

RR= Risk Ratio; * Mid-p exact; ** Chi-square test

Figure 1: Distribution of cancers by years.

Figure 2: Distribution of cancers by age and sex.

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Foma W et al. Int J Otorhinolaryngol Head Neck Surg. 2017 Jan;3(1):11-16

Table 3: Distribution of cancers by siege and age.

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